Lesiones cutáneas asociadas al uso de bombas de insulina y sistemas de monitoreo: un problema desafiante / Insulin pumps and glucose monitors related cutaneous lesions: a challenging problem

Los cuidados actuales de la diabetes incluyen altos niveles de tecnología y los pacientes utilizan diferentes dispositivos que pueden ayudar en su control metabólico, pero pueden impactar negativamente en su piel. Sensores de glucosa como el Freestyle, Dexcom, el Enlite de Medtronic y los sistemas de infusión continua de insulina contienen diferentes productos químicos que están en contacto directo con la piel del paciente y pueden causar una dermatitis irritativa o de contacto alérgica. Las lesiones incluyen eczema, prurito, heridas, cicatrices y cambios en la pigmentación de la piel. Los productos químicos involucrados que pueden ocasionarlas son el isobornil acrilato, N, N- dimetilacrilamida, etil cianoacrilato y colophonium, forzando a los pacientes a cambiar los sitios de infusión, el set de infusión o el sensor mismo más pronto de lo esperado, para reducir el nivel de daño en la piel. Existe gran número de productos que permiten proteger la piel y reducir el contacto de la piel con la cánula de la bomba o el sensor. Para reducir o prevenir el daño existen productos como cremas o spray y parches de hidrocoloide que actúan como barrera y existen técnicas para aplicar y retirar cuidadosamente los parches y adhesivos de los dispositivos. Una vez que las lesiones se han producido, el tratamiento incluye pomadas y a veces corticoides tópicos y/o antibióticos. Para prevenir o reducir el daño de la piel asociado al sensor y uso de la bomba de insulina, la industria que los produce debería incluir la información en relación a los productos químicos incluidos en cada dispositivo.

Diabetes care nowadays includes a high level of technology and patients use different devices which can help them in their glycemic control, but can have a negative impact on their skin. Glucose sensors such as Freestyle, Dexcom, Medtronic Enlite and also continuous subcutaneous insulin infusion systems contain different chemical products which are in direct contact with the patient's skin and can cause irritative or allergic contact dermatitis. Lesions include eczema, pruritus, wounds, scars and changes in skin pigmentation. The chemical products which can induce them are isobornyl acrylate, N, N- dimethylacrylamide, ethyl cyanoacrylate and colophonium, forcing patients to change the infusion site, set or the sensor itself, earlier than expected, in order to reduce the level of skin damage. There are a number of products which can protect the skin and reduce it's contact with the pump cannula or the sensor. To reduce or prevent damage, we have products such as barrier cream or spray films and hydrocolloid blister plasters and actions such as careful application and removal of device's patches and adhesives. Once lesions are established, treatment includes ointments and sometimes topical steroids and/ or antibiotics. In order to prevent or reduce skin damage related to sensor and insulin pump use, the manufacturers should include the information related to the chemicals included in each device.

Medical adhesive-related skin injury in cancer patients: A prospective cohort study / Lesión cutánea relacionada con adhesivos médicos en pacientes con cáncer: cohorte prospectiva / Lesão de pele relacionada a adesivo médico em paciente com câncer: coorte prospectiva

Objective: to estimate the incidence of medical adhesive-related skin injury in the peripheral venous catheter fixation region in critical cancer patients, to identify risk factors, and to establish a risk prediction model for its development. Method: a prospective cohort study with a sample of 100 adult and aged patients hospitalized in an intensive care unit. The data were analyzed using descriptive, bivariate and multivariate statistics with Cox regression. Results: the incidence of medical adhesive-related skin injury was 31.0% and the incidence density was 3.4 cases per 100 people-days. The risk factors were as follows: alcoholism, smoking habit, hospitalization due to deep vein thrombosis, acute respiratory failure, immediate postoperative period, heart disease, dyslipidemia, use of antiarrhythmics, blood transfusion, friction injury, pressure injury, turgor, edema, hematoma, petechiae, low values in the Braden scale, clinical severity of the patient, elasticity, moisture, texture and color. The predictive model consisted in the following: decreased skin turgor, presence of hematoma and edema. Conclusion: medical adhesive-related skin injury at the peripheral venous catheter insertion site has a high incidence in critical cancer patients and is associated with decreased turgor, presence of hematoma and edema, evidence that can support the clinical practice.

Objetivo: estimar la incidencia de lesión cutánea relacionada con adhesivos médicos en la región de fijación del catéter venoso periférico en pacientes oncológicos críticos, identificar factores de riesgo y establecer un modelo de predicción de riesgo para su desarrollo. Método: cohorte prospectiva con una muestra de 100 pacientes adultos y adultos mayores ingresados en una unidad de terapia intensiva. Los datos se analizaron mediante estadística descriptiva, bivariada y multivariada con regresión de Cox. Resultados: la incidencia de lesión cutánea relacionada con adhesivos médicos fue del 31,0% y la densidad de incidencia fue de 3,4 casos por 100 personas-día. Los factores de riesgo fueron: alcoholismo, tabaquismo, hospitalización por trombosis venosa profunda, insuficiencia respiratoria aguda, postoperatorio inmediato, cardiopatía, dislipidemia, uso de antiarrítmicos, transfusión de sangre, lesión por fricción, lesión por presión, turgencia, edema, hematoma, petequias, bajos valores en la escala de Braden, gravedad clínica del paciente, elasticidad, humedad, textura y coloración. El modelo predictivo estuvo compuesto por: disminución de la turgencia cutánea, presencia de hematomas y edema. Conclusión: la lesión cutánea relacionada con adhesivos médicos en el sitio de inserción del catéter venoso periférico tiene una alta incidencia en pacientes oncológicos críticos y se asocia a disminución de la turgencia, presencia de hematoma y edema, dicha evidencia puede servir de base para la práctica clínica.

Objetivo: estimar a incidência de lesão de pele relacionada a adesivo médico em região de fixação de cateter venoso periférico em pacientes oncológicos críticos, identificar fatores de risco e estabelecer modelo de predição de risco para o seu desenvolvimento. Método: coorte prospectiva com amostra de 100 pacientes adultos e idosos internados em unidade de terapia intensiva. Os dados foram analisados por estatística descritiva, bivariada e multivariada com regressão de Cox. Resultados: a incidência da lesão de pele relacionada a adesivo médico foi de 31,0% e a densidade de incidência foi de 3,4 casos por 100 pessoas-dia. Os fatores de risco foram: etilismo, tabagismo, internação por trombose venosa profunda, insuficiência respiratória aguda, pós-operatório imediato, cardiopatia, dislipidemia, uso de antiarrítmico, hemotransfusão, lesão por fricção, lesão por pressão, turgor, edema, hematoma, petéquias, valores baixos na escala de Braden, gravidade clínica do paciente, elasticidade, umidade, textura e coloração. Compuseram o modelo preditivo: turgor de pele diminuído, presença de hematomas e edema. Conclusão: a lesão de pele relacionada a adesivo médico em sítio de inserção de cateter venoso periférico tem elevada incidência em pacientes oncológicos críticos e está associada ao turgor diminuído, presença de hematoma e edema, evidências essas que podem embasar a prática clínica.

Biochemical changes following an Egyptian glue inhalation

This work was devoted to study the biochemical changes induced by inhaling a local glue Kolla", that is commonly and widely abused by street children in Egypt. The effect of single and repeated daily inhalation of this substance on certain brain neurotransmitters was studied in rats. Besides, the effect of this substance oil and kidney functions was investigated. Previous chemical analysis showed that the main volatile solvent ingredient of Kolla" is toluene and, thus, it was used as a standard solvent inhalant in this study. Two different concentrations of each inhalant, glue and toluene, were investigated. Single [30 mm] as well as repeated daily inhalation [30 mm/day for 10 days] of the two tested concentrations of each of "Kolla" [5000 and 10000 ppm] and toluene [28225 and 56450 ppm] increased the level of dopamine in rat's brain. Similarly, brain serotonin level increased following single inhalation of the high concentrations of both 'Kolla" and toluene. Serotonin level was also increased after repeated daily inhalation of the two toxic inhalants in the four tested concentrations. Liver and kidney function tests showed an increase in serum liver enzymes levels [ALT/GPT, AST/GOT and ALP] and in both serum urea and creatinine levels following single and repealed daily inhalation of each of Kolla" and toluene. In conclusion, glue inhalation leads to remarkable changes in some brain neurotransmitters and deleterious effects on liver and kidney function

The knowledge and attitude of general dentists toward denture adhesives in Tehran.

Background: The purpose of this study was to generate discussion and communication among a group of general dentists in Tehran on their viewpoints regarding denture adhesives. Have they accepted denture adhesive as a material to enhance denture retention, stability and function? Materials and Methods: In the summer of 2007, a questionnaire was mailed to 300 general dentists who were assigned with a random systematic sampling method from general dentists in Tehran. The questions were arranged in two parts of evaluating knowledge and attitude. In evaluation of knowledge, dentists were classified into groups of good, moderate, weak and lack of knowledge. In evaluation of attitude, dentists were classified into positive, moderate and negative groups. (Evaluating attitude was carried out in good and moderate groups of knowledge.) Results: The study showed that 14%, 32% and 37% of the general dentists had respectively good, moderate and weak knowledge toward denture adhesive while 16.3% had no knowledge about this material. In evaluation of attitude through dentists with positive and moderate knowledge toward denture adhesive, 9.3%, 71.3% and 19.4% had respectively positive, moderate and negative attitude toward denture adhesive. The c2 test showed a significant statistical relation between situation of knowledge and experiences of dentists. Discussion: This study demonstrated that the rate of knowledge of these 300 general dentists in Tehran towards denture adhesives has not been in a good situation. It is believed that denture adhesive be able to enhance the fitness of a denture and provide psychological relief to the patient. Dentists agreed that education, not only for practitioners but also for patients, would raise the advantageous features and reduce the misuse of denture adhesive. Education of the topic "Denture adhesive" should be more concerned in dental universities.

In vivo qualitative analysis of the biocompatibility of different cyanoacrylate-based adhesives

Cyanocrylates have been widely used in the medical and dental fields for several years. In Dentistry, cyanoacrylates have been used for suturing, pulp capping, as retrofilling material in endodontic surgeries, and as cervical plug for pulpless teeth bleaching. The biocompatibility of these adhesives has been the topic of many researches and subcutaneous implantation is an effective methodology for these studies. The present study evaluated the biocompatibility of three different cyanoacrylate-based adhesives. Thirty-six Wistar rats were used, divided into four groups of 9 animals each: A (control) - distilled water, B - cyanoacrylate ester (Super Bonder), C - n-butyl-cyanoacrylate (Histoacryl) and D - alpha-cyanoacrylate (Three Bond). The materials were dispensed in sponges of polyvinyl chloride, the animals were incised and the sponges were inserted in the subcutaneous tissue and sutured. Each group was sub-divided according to the time of sacrifice of the animals: 7, 21 and 45 days. Subjective analysis of the histologic material showed that all groups presented some degree of irritability, but the inflammatory reaction decreased with the experimental time in all groups. Group D showed an inflammatory reaction which was closer to that of the control group and was considered to have good biocompatibility. Groups B and C were similar and presented more aggressive inflammatory reactions when compared to the control group. Based on the results, it was concluded that alpha-cyanoacrylate (Three Bond) was the most biocompatible adhesive because it caused the lowest levels of inflammation.

Left main coronary artery ostial stenosis with biologic glue post-bentall procedure

We describe a case of acute occlusion of the left main coronary artery by a biologic glue same day after Bentall procedure for ectasia of the ascending aorta. Surgical treatment of this condition required emergency coronary artery bypass surgery

Instilación ocular casual con cianoacrilato / Unexpected occular instillation with cyanocrilate

The cyanocrilate is utilized in ophthalmology for the processing of small corneal drillings. We present the case of a male of 37 years that itself autoinstilo adhesive of cianoacrilatoin accidental form in its left eye. In spite of the spectacularness of the situation and the diligence of the extraction of the plates, evolution of the patient was good with reepitelización corneal complete and without subsequent consequences. The bibliographical references in ophthalmology refer to the instilaciones accidental, we contribute this clinical case along with a revision of the bibliography.

Efectos en la piel por el uso de cintas adhesivas en pacientes hemato oncológicos / Effects of diferent adhesive tapes in the skin of hemato oncology patients

Este trabajo trata de determinar qué elementos de fijación contribuyen a mantener la integridad de la piel sin producir alteraciones cutáneas, utilizando distntos accesos venosos, en distintos intervalos de tiempo, en los niños con patología oncológica que se atienden en el Hospital de Día del Hospital Garrahan. Los objetivos propuestos son determinar los efectos más comunes producidos por cada tipo de cinta (común, transpore, micropore, durapore, tegaderm)), determinar que tipo de fijacion es menos traumática, y cual es más traumática. Para este estudio de tipo descriptivo se utilizó un sensillo instrumento donde se recolectaron los datos del paciente detallando tipo de acceso usado, tiempo de permanencia, tipo de adehesivo, signo observado al retirar la fijacion. Se realizó la investigación sobre una muestra de 240 pacientes, (no probabilística, intencionada) a lo largo de dos meses julio - agosto/95. De lo analizado se puede afirmar que las cientas comunes son las que producen la mayor cantidad de casos de alteraciones cutáneas (54%).

Uso de novo adesivo cirúrgico em anastomoses do colo: estudo experimental em ratos / The use of a new surgical adhesive in large bowel anastomosis: an experimental study in rats

Estudo experimental realizado em 40 ratos divididos em 4 grupos de 10, com o objetivo de testar o uso de novo adesivo cirúrgico à base de resorcina e formol (Colagel R). No grupo I-A foi realizada anastomose do intestino grosso a 7cm do cecum com fio de polipropileno, provocando-se a contaminaçäo grosseira em torno da anastomose com colônias de Escherichia Coli. A pressäo intraluminar suportada pela anastomose teve a média de 254 mm Hg e näo ocorreram complicaçöes até o 7§ dia pós-operatório. Nas anastomoses feitas com o mesmo fio em plano único, sem contaminaçäo bacteriana, a média das pressöes suportadas foi de 285 mm HG e igualmente näo houve complicaçöes nas anastomoses. Quando se utilizou o adesivo (colagel) nos grupos II-A e II-B (com e sem contaminaçäo pela E. Coli respectivamente), houve mais de 50% de casos de obstruçäo intestinal, fístulas e deisses foram de 31 mmHg (grupo II-A) e 51 mmHg (grupo II-B). Concluiu-se que os resultados altamente desfavoráveis decorrentes do uso do adesivo sugerem que novos estudos experimentais sejam realizados, a fim de que sejam melhor analisados os efeitos levsivos aqui observados

Accidental tarsorrhaphy from cyanoacrylate adhesive in a baby

A 2 1/2-year-old boy rubbed his eyes with hands coated with cyanoacrylate adhesive [Crazy Glue], which resulted in accidental bilateral tarsorrhophy. Zephrin tincture 1/750 solution [10% acetone, 50% alcohol and a dye] applications proved successful in separating the eyelids. Some of the lashes had to be cut because the dried adhesive on them prevented the separation of the eyelids. The treatment also included the use of topical steroids, antibiotics and cycloplegics. The recovery was uneventful